Surgical Infection Society Guidelines for Antibiotic Use in Patients Undergoing Cholecystectomy for Gallbladder Disease

Surgical Infection Society guidelines on antibiotic use in gallstone surgery: high time we crack down on prophylactic antibiotics

“…Acute cholecystitis is often regarded as an infectious disease, though bacterial contamination of the bile is detected in only a minority of cases (5). In the absence of sufficiently powered randomised controlled trials assessing the benefit of antibiotic prophylaxis, most guidelines recommend treatment with antibiotics on admission for acute cholecystitis (2) demonstrate any benefit from antibiotic prophylaxis (6), whereas a slightly larger Dutch study showed a lower risk for surgical site infection if piperacillin was given as single dose (7). The recommendations remain the same, but the level of evidence has increased.…”

“…The United States Surgical Infection Society (SIS) has recently presented evidence-based guidelines for appropriate antibiotic use in patients undergoing cholecystectomy ( 2 ). These guidelines are based on randomised controlled trials and, to some extent, large cohort studies.…”

“…Numerous randomised controlled trials have also confirmed the lack of benefit from antibiotic prophylaxis in non-complicated gallstone disease. There is no doubt that routine use of antibiotic prophylaxis in such situations is bad clinical practice ( 2 ). Even so, the unnecessary use of antibiotics remains a worldwide problem ( 3 , 4 ).…”

“…Acute cholecystitis is often regarded as an infectious disease, though bacterial contamination of the bile is detected in only a minority of cases ( 5 ). In the absence of sufficiently powered randomised controlled trials assessing the benefit of antibiotic prophylaxis, most guidelines recommend treatment with antibiotics on admission for acute cholecystitis ( 2 ). However, since that literature review was conducted, two randomised controlled trials have been published.…”

“…Although there is a lack of large randomised controlled trials on postoperative antibiotic prophylaxis in uncomplicated gallstone surgery, and the trials conducted on acute cholecystitis have had limited power, this recommendation is logical as source control is achieved once cholecystectomy is completed and bile leakage has been ruled out. However, patients with severe acute cholecystitis (Tokyo Grade 3), i.e., those with secondary organ failure, are recommended postoperative antibiotics up to 4 days after surgery ( 2 ). This recommendation is based on a large multicentre trial on patients with complicated intra-abdominal infection where the primary source of infection was under control ( 9 ).…”